Target Health Blog

Migraines

July 23, 2018

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I've had a migraine/headache for 6 days straight. Today was so bad I couldn't concentrate on what I was saying. I'm not even sure I knew WHAT I was saying because of the pain. I even mixed up two people's names and felt really dumb afterwards. Anyone got a migraine cure? :)  Photo credit: Sasha Wolff from Grand Rapids - Can't Concentrate: 14/365, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=11343038

A migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, the headaches affect one half of the head, are pulsating in nature, and last from two to 72 hours. Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain is generally made worse by physical activity. Up to one-third of people have an aura: typically, a short period of visual disturbance that signals that the 1) ___ will soon occur. Occasionally, an aura can occur with little or no headache following it. Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families. Changing hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty and two to three times more women than men. The risk of migraines usually decreases during pregnancy. The underlying mechanisms are not fully known. They are, however, believed to involve the nerves and blood vessels of the 2) ___. Initial recommended treatment is with simple pain medication such as ibuprofen and paracetamol (acetaminophen) for the headache, medication for the nausea, and the avoidance of triggers. Specific medications such as triptans or ergotamines may be used in those for whom simple pain medications are not effective. Caffeine may be added to the above. A number of medications are useful to prevent attacks including metoprolol, valproate, and topiramate.

Globally, approximately 15% of people are affected by migraines. It most often starts at puberty and is worst during middle 3) ___. In some women they become less common following menopause. As of 2016 it is one of the most common causes of disability. An early description consistent with migraines is contained in the Ebers papyrus, written around 1500 BCE in ancient Egypt. The word "migraine" is from the Greek hemikrania, "pain on one side of the head", from hemi, "half", and kranion, "skull".

Migraines typically present with self-limited, recurrent severe headache associated with autonomic symptoms. About 15-30% of people with migraines experience migraines with an aura and those who have migraines with aura also frequently have migraines without aura. The severity of the pain, duration of the headache, and frequency of attacks are variable. A migraine lasting longer than 72 hours is termed status migrainosus. There are four possible phases to a migraine, although not all the phases are necessarily experienced. Prodromal is one of the phases, where premonitory symptoms occur in about 60% of those with migraines, with an onset that can range from two hours to two days before the start of pain or the aura. These symptoms may include a wide variety of phenomena, including altered mood, irritability, depression or euphoria, fatigue, craving for certain food(s), stiff muscles (especially in the neck), constipation or diarrhea, and sensitivity to smells or noise. This may occur in those with either migraine with aura or migraine without 4) ___.

Aura is a transient focal neurological phenomenon that occurs before or during the headache. Auras appear gradually over a number of minutes and generally last less than 60 minutes. Symptoms can be visual, sensory or motor in nature and many people experience more than one. Visual effects occur most frequently; they occur in up to 99% of cases and in more than 50% of cases are not accompanied by sensory or motor effects. Vision disturbances often consist of a scintillating scotoma (an area of partial alteration in the field of 5) ___ which flickers and may interfere with a person's ability to read or drive). These typically start near the center of vision and then spread out to the sides with zigzagging lines which have been described as looking like fortifications or walls of a castle. Usually the lines are in black and white but some people also see colored lines. Some people lose part of their field of vision known as hemianopsia while others experience blurring. Sensory aurae are the second most common type; they occur in 30-40% of people with auras. Often a feeling of pins-and-6) ___ begins on one side in the hand and arm and spreads to the nose - mouth area on the same side. Numbness usually occurs after the tingling has passed with a loss of position sense. Other symptoms of the aura phase can include speech or language disturbances, world spinning, and less commonly motor problems. Motor symptoms indicate that this is a hemiplegic migraine, and weakness often lasts longer than one hour unlike other auras. Auditory hallucinations or delusions have also been described.

In the Pain phase, classically the headache is unilateral, throbbing, and moderate to severe in intensity. It usually comes on gradually and is aggravated by physical activity. In more than 40% of cases, however, the pain may be bilateral and neck pain is commonly associated with it. Bilateral pain is particularly common in those who have migraines without an aura. Less commonly pain may occur primarily in the back or top of the head. The pain usually lasts 4 to 72 hours in adults, however in young children frequently lasts less than 1 hour. The frequency of attacks is variable, from a few in a lifetime to several a week, with the average being about one a month. The pain phase is frequently accompanied by nausea, vomiting, sensitivity to light, sensitivity to sound, sensitivity to smells, fatigue and irritability. In a basilar migraine, a migraine with neurological symptoms related to the brain stem or with neurological symptoms on both sides of the body, common effects include a sense of the world spinning, light-headedness, and confusion. Nausea occurs in almost 90% of people, and vomiting occurs in about one-third. Many thus seek a 7) ___ and quiet room. Other symptoms may include blurred vision, nasal stuffiness, diarrhea, frequent urination, pallor, or sweating. Swelling or tenderness of the scalp may occur as can neck stiffness. Associated symptoms are less common in the elderly.

Rarely, an aura occurs without a subsequent headache. This is known as an acephalgic migraine or silent migraine; however, it is difficult to assess the frequency of such cases because people who do not experience symptoms severe enough to seek treatment may not realize that anything unusual is happening to them and pass it off without reporting any problems. The migraine postdrome could be defined as that constellation of symptoms occurring once the acute headache has settled. Many report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. The person may feel tired or "hung over" and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness. According to one summary, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise." For some individuals this can vary each time. 

The underlying 8) ___ of migraines are unknown. However, they are believed to be related to a mix of environmental and genetic factors. They run in families in about two-thirds of cases and rarely occur due to a single gene defect. While migraines were once believed to be more common in those of high intelligence, this does not appear to be true. A number of psychological conditions are associated, including depression, anxiety, and bipolar disorder, as are many biological events or triggers. Migraines may be induced by triggers, with some reporting it as an influence in a minority of cases and others the majority. Many things such as fatigue, certain foods, and weather, psychological stress, PTSD, have been labeled as triggers; however, the strength and significance of these relationships are uncertain. A review on potential triggers in the indoor and outdoor environment concluded that there is insufficient evidence to confirm environmental factors as causing migraines. Migraines are believed to be a neurovascular disorder with evidence supporting its mechanisms starting within the brain and then spreading to the blood vessels. Some researchers believe neuronal mechanisms play a greater role, while others believe blood vessels play the key role. Others believe both are likely important. One theory is related to increased excitability of the cerebral 9) ___ and abnormal control of pain neurons in the trigeminal nucleus of the brainstem. Low levels of the neurotransmitter serotonin, also known as 5-hydroxytryptamine, are believed to be involved.

While acupuncture may be effective in reducing the number of migraines, "true" acupuncture has only a small effect when compared to sham acupuncture, a practice where needles are placed randomly. Triptans such as sumatriptan are effective for both pain and nausea in up to 75% of people. When sumatriptan is taken with naproxen it works better. They are the initially recommended treatments for those with moderate to severe pain or those with milder symptoms who do not respond to simple analgesics. The long-term effects of most migraine treatments are not known. 

Migraines most commonly start between 15 and 24 years of age and occur most frequently in those 35 to 45 years of age. In children, about 1.7% of 7 year olds and 3.9% of those between 7 and 15 years have migraines, with the condition being slightly more common in boys before puberty. During adolescence migraines become more common among women and this persists for the rest of the lifespan, being two times more common among elderly females than males. In women migraines without aura are more common than migraines with aura, however in men the two types occur with similar frequency. Worldwide, 10) ___ affect approximately one billion people. Sources:nih.gov; Wikipedia

ANSWERS: 1) headache; 2) brain; 3) age; 4) aura; 5) vision; 6) needles; 7) dark; 8) causes; 9) cortex; 10) migraines

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